Im­prov­ing women’s health with no guar­an­tee of get­ting paid

Modern Healthcare - - Q & A -

“We were the first hos­pi­tal in our state that put a hard stop on early elec­tive in­duc­tions, and that re­duced ad­mis­sions into our NICU sig­nif­i­cantly.”

Teri Fon­tenot is pres­i­dent and CEO of Women’s Hos­pi­tal in Ba­ton Rouge, the largest birthing and neona­tal in­ten­sive-care fa­cil­ity in Louisiana.

Fon­tenot spear­headed the con­struc­tion of a new 350-bed, $350 mil­lion fa­cil­ity that opened two years ago. Fon­tenot was the 2012 chair of the Amer­i­can Hos­pi­tal As­so­ci­a­tion board of trus­tees. She was named to Mod­ern Health­care’s 100 Most In­flu­en­tial Peo­ple in Health­care in 2011 and 2012. Mod­ern Health­care Ed­i­tor Mer­rill Goozner talked with her about ac­count­able care or­ga­ni­za­tions, the con­tro­versy over abor­tion ac­cess in her state and how a women’s hos­pi­tal can im­prove care for low-in­come women. This is an edited tran­script.

Mod­ern Health­care: You took out a very large bond is­sue for build­ing your new hos­pi­tal, but your re­cent fi­nan­cial state­ments show your sit­u­a­tion is im­prov­ing some­what. What have you been do­ing to im­prove the fi­nan­cial pic­ture?

Teri Fon­tenot: We moved the hos­pi­tal to a green­field cam­pus be­cause we knew that we needed to ex­pand, and we needed larger spa­ces for our an­cil­lary ser­vices like phar­macy and imag­ing. We ac­tu­ally have fewer beds at our new cam­pus. But we were able to more than dou­ble the size of our physician of­fice build­ing, and we have plans for ex­pan­sion into other ser­vices that sup­port women be­yond ob­stet­ric.

Mod­ern Health­care: What are you do­ing on ac­count­able care or­ga­ni­za­tions?

Teri Fon­tenot: We will never be a true ACO be­cause we don’t plan to take on pre­mium risk. But the types of ser­vices we tra­di­tion­ally pro­vide have had some sort of fixed pay­ment. Our largest payer is Med­i­caid, which pays us a flat amount per day. So we’ve had the in­cen­tive for years to fig­ure out how to get good out­comes on a fixed pay­ment. Be­cause our doc­tors still are mostly in pri­vate prac­tice, where we see op­por­tu­nity go­ing for­ward is be­com­ing more aligned and in­te­grated with them than we are now.

MH: Won’t be­com­ing more in­te­grated with physi­cians do­ing pre­na­tal care po­ten­tially re­duce your ad­mis­sions or the use of your NICU?

Fon­tenot: It ab­so­lutely will. But our mis­sion is to im­prove the health of women and in­fants. We were the first hos­pi­tal in our state that put a hard stop on early elec­tive in­duc­tions, and that re­duced ad­mis­sions into our NICU sig­nif­i­cantly. Be­ing able to align bet­ter with the doc­tors gives us the op­por­tu­nity to work with pa­tients pre­na­tally where we don’t re­ally have a good op­por­tu­nity now.

MH: Have you been able to work with em­ploy­ers and in­sur­ers to con­vince them that there’s a bet­ter value propo­si­tion there?

Fon­tenot: We cer­tainly have ap­proached them about it and told them that we are very in­ter­ested in ex­per­i­men­ta­tion with them. Hope­fully, through data anal­y­sis we will be able to con­vince them we can im­prove the out­comes. But we have no con­tracts like that yet.

MH: You don’t per­form elec­tive abor­tions at Women’s Hos­pi­tal. Louisiana has a new law that would re­quire abor­tion providers to have ad­mit­ting priv­i­leges at a hos­pi­tal within 30 miles be­fore they can per­form elec­tive abor­tions. How is that play­ing out?

Fon­tenot: Those op­posed to the law feel like it’s go­ing to limit pa­tient safety and limit ac­cess to care. Those who sup­port the law be­lieve that if pa­tients have a prob­lem, cur­rently they are show­ing up in hos­pi­tal emer­gency de­part­ments and there’s not any in­for­ma­tion about that pa­tient or her con­di­tion.

MH: Why aren’t lo­cal providers will­ing to pro­vide elec­tive abor­tions?

Fon­tenot: In Ba­ton Rouge, ob­ste­tri­cians work­ing at hos­pi­tals like Women’s have de­cided that’s not some­thing they’re in­ter­ested in pro­vid­ing.

MH: Would ACOs be a bet­ter way to go for your low-in­come women pa­tients?

Fon­tenot: Most def­i­nitely, be­cause many times pa­tients, when they be­come preg­nant, re­ally don’t have a med­i­cal home. When the ob­ste­tri­cian is pro­vid­ing pre­na­tal care, the pa­tients may have other con­di­tions such as STDs, HIV or ges­ta­tional di­a­betes. Women’s Hos­pi­tal could work more col­lab­o­ra­tively with the physi­cians dur­ing the pre­na­tal pe­riod, be­ing able to share in­for­ma­tion through elec­tronic health records, and im­prov­ing out­comes and hope­fully pre­ma­ture births.

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